BMJ Case Reports
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More common than you think: The potentially fatal consequences of swallowing a toothpick

A compilation of doctors’ reports on such instances make up a cautionary tale in the latest BMJ Case Reports.

SWALLOWING TOOTHPICKS IS rare, but potentially very dangerous, and can result in conditions such as perforated bowel and even be fatal, according to doctors writing in the British Medical Journal Case Reports.

Having reached 15,000 articles, the peer-reviewed journal has decided to highlight a few cautionary tales to highlight the frequency of seemingly innocuous things that can happen in the home.

Three of these stories involved a patient developing serious symptoms having swallowed a toothpick. In some cases, it took quite some time before doctors were able to figure out the cause.

Greater risk

In one case in Belfast, a 77-year-old man arrived in A&E with a sudden onset of sharp abdominal pain in his right hand side.

A CT scan showed abnormal results including a penetration of his bowel wall measuring 3cm. Further tests showed he had a perforation due to an ingested toothpick.

The doctors said that older people wearing dental plates or dentures were at greater risk of ingesting toothpicks.

They wrote: “The majority of patients with knowledge of toothpick ingestion will come to no adverse effect with the offending object passing without internal injury.

However, the incidence of internal injury has been reported to be as high as 30% following toothpick ingestion, significantly higher than other ingested foreign bodies… owing to the double-pointed nature of a toothpick.

They went on to say that patients can be unaware of ingesting toothpicks, making it harder for doctors to diagnose patients when they first present.

The paper closes with a recommendation for doctors to check for ingestion of foreign bodies such as toothpicks when the underlying pathology of a person’s pain is in doubt.

Potentially fatal

In another case in Australia, a 70-year-old woman presented with recurrent pain in her left lower quadrant.

She went on to suffer acute diverticulitis – bowel obstruction that can cause constipation, thin stools and abdominal pain – before it was discovered she’d swallowed a toothpick.

The patient consented to an operation to prevent further damage.

The doctors wrote: “The main risk factors for toothpick ingestion include meals containing toothpicks and accompanied by alcoholic beverages, male gender and habit of tooth chewing.

The reported mortality associated with perforation from toothpick ingestion is 9.6%, and of these patients 38% died despite successful removal of the toothpick.

In this case, they said that the possibility of having swallowed a toothpick was not initially considered, with the patient denying having used one and not able to recall a meal served with one.

Furthermore, they added that the toothpick passing through the body without causing further damage was very unlikely in this case.

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